21st Century Cures Act

On December 7, 2016 Congress passed the 21st Century Cures Act (the “Act”), which was signed into law on December 14, 2016. The Act is aimed at modernizing health care delivery, improving quality and targeted improvements in the area of cancer treatment, mental health care, opioid addiction, and other focused areas. One such modernization effort requires states to implement Electronic Visit Verification (EVV) systems for personal care services and home health care services providers by 2019 and 2023, respectively. These EVV systems will help ensure that beneficiaries receive the care that is being billed to Medicaid. Additionally, the Act allocates over $1 billion in grant funding over the next two years for states to combat the opioid epidemic. States began the application process for grant funds in early 2017, and efforts are now underway in a number of states to implement new programs and services focused on treatment and prevention. Below we highlight one way PCG has identified to leverage existing claims data to implement reforms. This Act is largely funded through the Prevention and Public Health fund established in the Affordable Care Act (ACA). For more information on additional modernization and reform elements of the Act, please click here. [More]

Technology Solutions presents ‘next generation social prescribing’

On May 18, members of the PCG Technology Solutions team in the UK represented PCG at a one-day conference to present its technology solution for ‘social prescribing.’ The event, organised by the King’s Fund, brought together more than 400 senior representatives including national and local leaders for strategic collaboration and sharing of best practices. The event was a sell-out within weeks, attracting double the number of expected delegates, demonstrating the significant appetite for social prescribing in the UK. Such was the level of interest that the Prince of Wales, President of the King’s Fund attended to show his support for the innovative work that is taking place in this area. [More]

Massachusetts Supreme Judicial Court holds that the retention of the right to live in a home transferred to an irrevocable trust does not render the home an “asset” for Medicaid purposes

On May 31, 2017, the Supreme Judicial Court of Massachusetts reversed and remanded two cases involving determinations of eligibility for long-term care assistance under the Massachusetts Medicaid program (MassHealth). Nadeau v. Director of the Office of Medicaid and Daley v. Secretary of the Executive Office of Health and Human Services, SJC 12200 and 12205, May 31, 2017. [More]

CBO estimates that AHCA would severely increase the number of uninsured persons

On May 24, 2017, the Congressional Budget Office (CBO) and the Joint Committee on Taxation (JCT) released estimates on the impact of the proposed H.R. 1628, the American Health Care Act of 2017 (AHCA), as passed by the U.S. House of Representatives on May 4, 2017. AHCA would partly repeal the Affordable Care Act (ACA). The CBO estimates that AHCA would severely increase the number of persons without health coverage, as compared to the ACA... [More]

States seek to intervene in House v. Price lawsuit

On May 18, 2017, 15 states and the District of Columbia filed a motion to intervene in House v. Price, a lawsuit threatening the availability of federal funds (about $9 billion in 2017) for cost-sharing reduction (CSR) payments to health insurers under the Affordable Care Act (ACA). The lawsuit pertains to whether or not CSR payments are subject to annual Congressional appropriations. It was initially filed in November 2014 in U.S. District Court, which ruled in favor of the U.S. House of Representatives in May 2016, but held its decision in abeyance pending appeal. It is now before the U.S. Circuit Court of Appeals in the District of Columbia. [More]

Medicaid Member Engagement: One Size Does Not Fit All

There’s a certain catch-phrase going around related to Medicaid members: they need to have “skin in the game.” This phrase seems to imply that individuals receiving Medicaid are somehow different than other individuals—those who have private insurance—but they’re not. Individuals receiving healthcare through Medicaid are just like you and me. They want their children to be healthy and happy. They want to improve their health. They want to live happy and productive lives. However, due to life circumstances, some of them may need a little more assistance than others in understanding the role they play in their healthcare. Effective member engagement can help guide individuals through the complex Medicaid system of care. Medicaid’s population is very diverse and serves individuals from different socioeconomic backgrounds—the aged, blind, disabled, children, pregnant women, relatives taking care of children, and childless adults can qualify for Medicaid if they meet state specific guidelines. Activities to engage Medicaid members in their healthcare need to be as diverse as the population. Mass mailings to the entire population may not be as effective as specific information targeted to a select group of individuals. [More]

New ACA-Related announcements from the Federal Administration

The administration is taking more limited steps to influence implementation of the law, including two upcoming changes to enrollment through Marketplaces announcements last month. On May 15, the Centers for Medicare and Medicaid Services (CMS) announced that it will be proposing a rule to have enrollment into Federally-facilitated Small Business Marketplace (known as Small Business Health Options Program or “SHOP”) health insurance plans go directly through insurers as of 2018. Two days later, on May 17, CMS released guidance enabling (but not requiring) full direct enrollment in individual market Federally-facilitated Marketplace (FFM) plans starting for open enrollment for plan year 2018. [More]

NGA calls for Congressional action on CHIP renewal

On May 11, 2017, the National Governors Association (NGA) released a letter to the Senate Finance Committee and the House Committee on Energy and Commerce calling for Congressional action to renew funding for the Children’s Health Insurance Program (CHIP) for five more years. The letter is signed by Virginia Governor Terry McAuliffe, NGA Chair, and Massachusetts Governor Charlie Baker, NGA Vice-Chair for Health and Human Services. [More]

PCG kicks off powerful, innovative My Brother’s Keeper (MBK) series this week

Join us this Thursday, May 18, for the inaugural session of our MBK Forum series. We are delighted to welcome Mr. Glenn Singleton to speak about “COURAGEOUS CONVERSATIONS ABOUT RACE.”

Mr. Singleton founded Pacific Educational Group (PEG) in 1992, committed to achieving racial equity in education. Glenn and his group engage in sustained partnerships with educational organizations to transform beliefs, behaviors, and results so people of all races can achieve at their highest levels and live their most empowered and powerful lives. COURAGEOUS CONVERSATION™ is their award-winning protocol for effectively engaging, sustaining and deepening interracial dialogue. Through their Framework for Systemic Racial Equity Transformation, PEG is dedicated to helping educators address persistent racial disparities intentionally, explicitly, and comprehensively. [More]

Array of Services - Having It All

Providing families, parents, and children services that support and improve family relationships, family dynamics, and individual responsibilities has always been a primary responsibility of the child protection system. This system is comprised of complicated, intricate, integrated, and interrelated parts, each of which must perform well in order to achieve the ultimate goal: supporting children and families. From the report of a suspicion of abuse or neglect, to the assessment, filing with the court, court hearings, and finally closure, every individual in the process must perform well. [More]